Could we use abdominal compressions rather than chest compression in patients who arrest after cardiac surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether abdominal cardiopulmonary resuscitation (CPR) could be used instead of external cardiac massage either to protect the recent sternotomy or while chest compressions are not possible whilst a sternotomy is being performed. Altogether 386 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Patients who arrest after cardiac surgery and require chest reopening will have a period of no external chest compression and therefore, no cerebral or coronary perfusion. In addition, if a patient arrests prior to cardiac surgery there will be a period of time performing the sternotomy during which there will be no external compressions. We found only one paper in a porcine model that looked at the effectiveness of abdominal only CPR although it did show that abdominal CPR was actually 60% better than chest CPR. Interposed abdominal and chest compressions has been much more extensively studied and has been shown to be significantly better in return of spontaneous circulation than chest compressions alone. We conclude that currently there is very little evidence to support abdominal only CPR although these studies may support the concept that it may potentially increase the coronary and cerebral perfusion pressure.
Adam
Zulfiquar
Z
Department of Cardiology, James Cook University Hospital, Middlesbrough, UK. adamz@doctors.org.uk
Adam
Safwaan
S
Khan
Pia
P
Dunning
Joel
J
D000005:Abdomen; D000818:Animals; D019985:Benchmarking; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000379:methods*; D002560:Cerebrovascular Circulation; D003326:Coronary Circulation; D019317:Evidence-Based Medicine; D006323:Heart Arrest / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006336:Heart Massage / Q000009:adverse effects; D006801:Humans; D012086:Reoperation; D013249:Sternum / Q000601:surgery; D016896:Treatment Outcome